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Published on: December 2, 2014
Association between arterial stiffness and peritoneal fluid kinetics
Xing-wei Zhe1, Xin-kui Tian, Wei Chen
1Division of Nephrology, Peking University Third Hospital, Beijing, China.
Insights
High peritoneal transport in continuous ambulatory peritoneal dialysis (CAPD) patients is linked to increased aortic stiffness. This study found peritoneal fluid transport rate (Ke) and extracellular water to total body water (E/T) ratio are independent predictors of arterial stiffness in CAPD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- High peritoneal transport in continuous ambulatory peritoneal dialysis (CAPD) patients correlates with increased morbidity and mortality.
- Cardiovascular disease accounts for 40-50% of deaths in dialysis patients.
- Arterial stiffness is a known cardiovascular risk factor, but its link to peritoneal transport status is unexplored.
Purpose of the Study:
- To investigate the relationship between peritoneal transport status and aortic stiffness in CAPD patients.
- To identify predictors of arterial stiffness in this patient population.
Main Methods:
- Cross-sectional study of 65 prevalent CAPD patients.
- Arterial stiffness assessed by brachial pulse pressure (PP) and carotid-femoral pulse wave velocity (C-F PWV).
- Peritoneal fluid transport evaluated by kinetic modeling (Ke) and D/P(cr) at 4 h; extracellular water to total body water (E/T) ratio assessed by bioimpedance analysis.
Main Results:
- C-F PWV positively correlated with age, diabetic status, peritoneal fluid absorption rate (Ke), PP, and E/T ratio.
- Multivariate regression identified E/T ratio, PP, age, and Ke as independent predictors of C-F PWV.
Conclusions:
- Peritoneal fluid transport rate (Ke) and E/T ratio are independent predictors of elevated C-F PWV in CAPD patients.
- Findings suggest a potential link between high aortic stiffness and increased peritoneal transport (Ke), possibly via generalized vasculopathy.
Background:
A high peritoneal transport status in continuous ambulatory peritoneal dialysis (CAPD) patients is associated with a markedly increased morbidity and mortality. While the causes are as yet unknown, overall the proportion of deaths due to cardiovascular disease is estimated at 40-50% among dialysis patients. Arterial stiffness has been established as a cardiovascular risk factor, while the links between peritoneal transport status and aortic stiffness have not yet been investigated.
Methods:
We included 65 prevalent CAPD patients (24 males/41 females) from our center in a cross-sectional study. Arterial stiffness was assessed by brachial pulse pressure (PP) and carotid-femoral pulse wave velocity (C-F PWV). The patients' peritoneal fluid transport was assessed by kinetic modeling. The patients' peritoneal small solute transport rate was assessed by D/P(cr) at 4 h. Extracellular water to total body water (E/T) ratio was assessed by means of bioimpedance analysis. C-reactive protein was also measured.
Results:
C-F PWV was positively correlated with patients' age (r = 0.489, p < 0.01), diabetic status (r = 0.327, p < 0.01), peritoneal fluid absorption rate (Ke; r = 0.251, p < 0.05), PP (r = 0.483, p < 0.01), and E/T (r = 0.517, p < 0.01). Multivariate regression analysis showed that C-F PWV was independently related to E/T (p < 0.01), PP (p < 0.01), age (p < 0.05), and Ke (p < 0.05).
Conclusion:
Peritoneal fluid transport (Ke), as well as E/T, age and PP were found to be independent predictors of elevated C-F PWV in CAPD patients, suggesting that there might be a link between high aortic stiffness and increased Ke rate, hypothetically through generalized vasculopathy.
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